Atypical pneumonia - Q fever

Presentation

Fevers, abnormal LFT's, abdominal tenderness, respiratory compromise and pancytopaenia. Preceding symptoms of gastroenteritis and diarrhoea.

Patient Data

Age: 50
Gender: Male

CXR

Modality: X-ray

The right hemidiaphragm is elevated with some minor right basal atelectasis.  It is not clear whether elevation of the right hemidiaphragm reflects sub diaphragmatic pathology or is longstanding in nature.

Hazy airspace opacity is seen in the left mid and upper zone which may be inflammatory in nature.  No areas of confluent consolidation are identified.

Cardiomediastinal contour is within normal limits.

An orthopaedic screw transfixes a mid shaft clavicular fracture on the right. Calcifications in the left axilla. Anterior wedging of L1 vertebral body.

CT

Modality: CT

Scattered ground glass opacification is seen bilaterally, predominantly in the upper zones and worst on the left with a "crazy paving" distribution. Small cysts are seen scattered throughout with more significant parenchymal distortions seen at the apices. An area with sub-pleural septal thickening is seen in a dependent position in the left lower lobe. No nodules are identified.

No mediastinal lymph adenopathy. No pleural fluid collections. The heart is not enlarged. Internal fixation of the right clavicle noted. No acute bony lesions.

Conclusion: The appearance of the lungs is non-specific and may represent oedema, atypical infection, pulmonary haemorrhage and drug toxicity. The predominantly upper zone distribution, the appearance of multiple pneumatoceles and the absence of pleural effusions  raises the possibility of PCP specifically.

Numerous microbiological organisms were sought. The positive result:

ATYPICAL PNEUMONIA SEROLOGY

Qfever (C.burnetii) Phase II Total Ab by IF :        >=1280 POSITIVE.

Qfever (C.burnetii) Phase II IgM by EIA :              DETECTED

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Case Information

rID: 21993
Case created: 3rd Mar 2013
Last edited: 7th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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